Sheffield Credit Union

Application for membership through payroll

Please print off this form, complete all sections and bring / send it to:

Sheffield Credit Union, Unit 6 North Gallery, Exchange Street, Sheffield, S2 5TR

Title: _______  Forenames: __________________________   Surname: ___________________

Address: ______________________________________________________________________

______________________________________________________________________________

Post Code _________     Telephone __________________

Date of Birth _______________   National Insurance number _______________

Company _____________________________   Department ___________________________

Bank account details

Required for BACS payments to you and as an alternative to providing other forms of identification.

Name of account holder ______________________

Bank / Building society ________________________

Account number _____________ Sort code ________  Reference (if required) ____________

Form of nomination

In the event of my death I nominate the following person(s) to whom there shall be transferred such property in the Sheffield Credit Union as is mine at the time of death, whether in shares or otherwise.

Nominee Name(s) _______________________________

Address _______________________________________________________________

______________________________________________________________________

Witnessed by (Name) ___________________________

Witness signature ______________________________

Note: The witness must not be the person nominated.

Declaration: I hereby apply for membership and agree to abide by the rules of Sheffield Credit Union and declare that the information given is correct to the best of my knowledge.

Signed _____________________      Date ________________

Authorised and regulated by the Financial Services Authority 213679                                Produced 08/07/2005